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If you are found to be eligible to take part in this study, you will be randomly assigned (as in the flip of a coin) to 1 of 2 study groups. You will have an equal chance of being assigned to either group:

If you are in Group 1, you will receive whole brain radiation treatment.

If you are in Group 2, you will receive stereotactic radiosurgery.

Study Procedures:

If you are in Group 1, you will receive whole brain radiation treatment each day, Monday-Friday starting on Day 1. If you are an inpatient, you may receive radiation treatment on weekends as well. You will continue to receive radiation treatment up to Day 14.

If you are in Group 2, you will receive stereotactic radiosurgery on Day 1. As part of the stereotactic radiosurgery procedure, you will receive a very accurate kind of MRI scan on the morning of the procedure. If this MRI scan identifies more tumors, you may still continue to participate in the study with up to 20 tumors. If there are more than 20 tumors found on the treatment planning MRI scan on the day of the SRS treatment, then you are not eligible to participate in the study. In this case, your study doctor will discuss with you other treatment options off of the study, which may include stereotactic radiosurgery and/or whole brain radiation therapy.

No matter which group you are in, you will sign a separate consent form for whole brain radiation or stereotactic radiosurgery that will explain the procedures and risks in detail.

Study Visits:

At 1, 4, 6, 9, and 12 months (+/- 14 days) after your assigned treatment, you will return to the clinic:

You will have a physical exam, including measurement of your vital signs.

You will be asked about any drugs you may be taking.

You will have an MRI scan to check the status of the disease.

You will complete the 7 cognitive function tests.

You will complete 3 questionnaires that ask about your quality of life and any symptoms you may be having.

Length of Study Participation:

Your active participation on the study will be over when you have completed the follow-up visits.

Follow-Up Visits:

If the study doctor thinks it is needed, you will return to the clinic for follow-up visits. The following tests and procedures will be performed:

You will have a physical exam, including measurement of your vital signs.

Dose based on largest diameter lesion as measured on volumetric MRI, modified as follows: 20-24 Gy for lesions 2 cm or less in size, 16-18 Gy for lesions >2-2.5 cm in size, and 12-16 Gy for lesions >2.5-3.5 cm in size. SRS performed on day 1.

Radiation: Stereotactic Radiosurgery (SRS)

Dose based on largest diameter lesion as measured on volumetric MRI, as follows: 20-24 Gy for lesions 2 cm or less in size, 16-18 Gy for lesions >2-2.5 cm in size, and 12-16 Gy for lesions >2.5-3.5 cm in size. SRS performed on day 1.

Other Names:

XRT

Radiation therapy

Behavioral: Questionnaires

Three (3) sets of quality of life (QOL) questionnaires completed 1, 4, 6, 9, and 12 months after assigned treatment.

Lesions assessed using contrast-enhanced MRI scans. Progressive disease (PD) considered local failure, or stable disease with deterioration of neurological examination with a grade III or worse toxicity on the CTC AE v.4.0 scale. Local control measured by contrast-enhanced brain MRI scan using modified RECIST criteria. Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in sum of diameters of target lesions. Progressive Disease (PD): At least a 20% increase in sum of diameters of target lesions. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. For local control, PD considered local failure, or stable disease with deterioration of neurological examination with a grade III or worse toxicity on the CTC AE v.4.0 scale. All others (CR, PR, asymptomatic SD) are deemed success.

Cognitive Decline [ Time Frame: 4 months ]

Baseline Hopkins Verbal Learning Testing-Revised (HVLT-R) score compared to HVLT-R score in patients surviving 4 months. Preservation of function defined as improvement of HVLT-R score or decline by 4 points or less. Failure defined as decline by 5 or more points. Time to neurocognitive decline estimated for each treatment arm using product limit estimator of Kaplan and Meier.

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:

18 Years and older (Adult, Senior)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

All patients must have histological proof of malignant cancer, which is metastatic. Histological proof may be obtained from the primary tumor or another metastatic site. However, cytology alone is not an acceptable method of diagnosis.

All patients must have greater than 3 but less than or equal to 15 metastatic lesions seen on a contrast enhancing MRI scan obtained not less than one month prior to study enrollment. Patients who are found to have up to 20 metastatic lesions at the time of treatment planning (on volumetric MRI once the head frame is in place) may still participate in the trial.

All patients must be >/= 18 years of age.

All patients must sign informed consent verifying that they are aware of the investigational nature of this study in keeping with the rules and policies of M.D. Anderson Cancer Center. The only acceptable consent form is the one attached at the end of this protocol, and it must have been approved and amended by the M.D. Anderson IRB.

All patients must be eligible to have all lesions treated with SRS (i.e. maximum diameter of largest lesion < 3.5cm) as determined by the radiation oncologist .

All patients should have normal coagulation, with international normalized ratio (INR) < 1.3 and able to withhold anti-coagulation medications a minimum of 24 hours prior to radiosurgery (or until INR normalizes), on the day of treatment and 24 hours after radiosurgery has concluded. Those patients getting WBRT may continue these medications.

Patients can be undergoing concurrent systemic therapy, such as temozolomide, at the discretion of their treating oncologist.

Exclusion Criteria:

Patients are excluded from this trial if they have melanoma, small cell carcinoma, lymphoma/leukemia, or germ cell histology (note, melanoma patients will be eligible for the sister trial to this trial which will be open simultaneously).

Patients will be excluded if they have had prior surgical resection of metastatic cancer from the brain.

Patients will be excluded if there is radiographic or CSF cytological evidence of leptomeningeal disease.

Patients will be excluded if they have had prior Whole Brain Radiotherapy (WBRT) or prophylactic cranial irradiation (PCI). Prior SRS or Gamma Knife radiosurgery to 1-3 metastases with minimum of (6) weeks to the most recent scan are allowed on protocol.

Female patients of childbearing age will be excluded if they are pregnant as assessed by serum b-HCG or urine pregnancy test. A serum b-HCG test or urine pregnancy test will be performed no greater than 14 days prior to study registration.

Patients will be excluded if they are unable to obtain an MRI scan.

Patients will be excluded if they have < 4 lesions, or > 15 lesions at enrollment or > 20 lesions at the time of treatment (note: patients who qualify for enrollment based on having 4-15 lesions, but who are discovered to have up to 20 lesions on the volumetric MRI used for treatment planning will be allowed to continue on study).